Cotinine levels and green tobacco sickness among shade-tobacco workers

J Agromedicine. 2005;10(2):27-37. doi: 10.1300/J096v10n02_05.


Study objective: Symptoms consistent with Green Tobacco Sickness (GTS) were found in 4% (13/331) to 15% (45/303) of the migrant, mostly Latino, shade-tobacco workers who sought medical care at a Connecticut clinic. The objective of this study was to determine whether or not shade-tobacco farm workers absorb nicotine from the tobacco leaves and have a corresponding increase in both salivary cotinine levels (a breakdown product of nicotine) and symptoms consistent with GTS.

Methods: The study utilized a prospective cohort design to evaluate salivary cotinine and symptoms consistent with GTS in a population of shade tobacco farm workers compared to a control group of nursery workers. The workers were assessed at two points in time, the early tobacco planting season and the harvest season.

Results: There was not a significant increase in salivary cotinine levels among shade-tobacco workers. Salivary cotinine levels over the work season did not significantly increase in shade-tobacco workers when compared with nursery workers. During the harvest season, none of the tobacco workers reported symptoms consistent with GTS.

Conclusions: Migrant workers in Connecticut who harvest shade-tobacco appear to have a low-risk of occupational nicotine dermal absorption and a low incidence of GTS. The work practices associated with harvesting shade-tobacco, in addition to the fact that shade tobacco may actually have a lower level of nicotine than either burley or flue cured tobacco, may explain these results. Our study appears to reinforce the GTS prevention recommendations made by investigators in other tobacco growing regions, specifically the importance of minimizing close skin contact with tobacco leaves and avoiding dermal contact with the plants when they are wet.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Agricultural Workers' Diseases / chemically induced
  • Agricultural Workers' Diseases / diagnosis
  • Agricultural Workers' Diseases / epidemiology*
  • Cohort Studies
  • Connecticut / epidemiology
  • Cotinine / analysis*
  • Female
  • Humans
  • Male
  • Nicotiana* / chemistry
  • Nicotiana* / poisoning
  • Nicotine / metabolism
  • Nicotine / poisoning*
  • Prevalence
  • Prospective Studies
  • Saliva / chemistry*
  • Skin Absorption


  • Nicotine
  • Cotinine